McKinney-Vento Homeless Eligibility and Transportation Request Form
In order to determine if the student meets eligibility criteria for rights and services provided under the McKinney-Vento Homeless Assistance Act answer the below questions and click "submit". The form will be submitted to the District Homeless Liaison for final approval. To qualify, the student must lack a fixed, regular, adequate nighttime residence. If you have any questions contact District Homeless Liaison 763-585-7376 solystk@district279.org
Request Type:
*
Please Select
Initial Eligibility Request
Change/Cancel Request
Name of Person Submitting Form:
*
First Name
Last Name
Email of Person Submitting Form:
*
example@example.com
Phone # of Person Submitting Form:
Please enter a valid phone number.
Back
Next
Student Name:
*
First Name
Last Name
Student Perm ID Number:
*
(Not State ID)
Enter Date (homeless) (REQUIRED SYNERGY)
*
-
Month
-
Day
Year
Must be on or after 9/2/25
Date of Homeless Identification: (REQUIRED SYNERGY)
-
Month
-
Day
Year
Nighttime Residence -where did the student stay last night? (REQUIRED SYNERGY)
*
Doubled up - temporarily sharing housing with others due to housing loss or hardship
Hotels/motels - temporarily due to housing loss or hardship
Shelters
Transitional Housing
Unsheltered - car, park, public place, substandard housing, etc.
Unaccompanied Youth - student is on his/her own: (REQUIRED SYNERGY)
*
Yes
No
Date of Birth:
/
Month
/
Day
Year
Date
Gender student identifies with:
Pronouns the student goes by:
she/her
he/him
they/them
Name student goes by if not given name or name on file:
Parent/Guardian Name:
*
First Name
Last Name
Parent/Guardian Phone Number:
*
Please enter a valid phone number.
Parent/Guardian Email:
*
example@example.com
Would student prefer to be contacted directly?
Yes
No
Student's Phone Number
Please enter a valid phone number.
Student's e-mail
example@example.com
Can the parent/guardian be contacted?
*
Yes
No
Can the parent/guardian receive transportation information via text?
*
Yes
No
Emergency Contact:
First Name
Last Name
Emergency Contact Phone Number:
Please enter a valid phone number.
Grade:
*
Please Select
ECSE
ECFE
Pre-K
KG
01
02
03
04
05 - review for school promotion
06
07
08 - review for school promotion
09
10
11
12
School:
*
Please Select
279 Online
Anne Bremer Education Center
Arbor View Early Childhood
Basswood Elementary 8:50am - 3:20pm
Birch Grove Elementary 9:30am - 4:00pm
Brooklyn Middle School 8:10am - 2:40pm
Cedar Island Elementary 9:30am - 4:00pm
Crest View Elementary 8:40am - 3:20pm
Edinbrook Elementary 8:50am - 3:20pm
Elm Creek Elementary 8:50am - 3:20pm
Fair Oaks Elementary 9:30am - 4:00pm
Fernbrook Elementary 8:50am - 3:20pm
Garden City Elementary 9:30am - 4:00pm
Maple Grove Middle 8:10am - 2:40pm
Maple Grove Senior 7:30am - 2:00pm
NECA
North Education Center
North View Middle 8:10am - 2:40pm
Oak View Elementary 9:30am - 4:00pm
OALC 8:50am - 3:20am
Osseo Education Center 8:10am -2:40pm
Osseo Middle School 8:10am - 2:40pm
Osseo Senior High 7:30am - 2:00pm
Palmer Lake Elementary 8:50am - 3:20pm
Park Brook Elementary 8:50am - 3:20pm
Park Center Senior High 7:30am - 2:00pm
Rice Lake Elementary 8:50am - 3:20pm
Rush Creek Elementary9:30am - 4:00pm
South Education Center
Weaver Lake Elementary 9:30am - 4:00pm
West Education Center
Willow Lane Early Childhood
Woodland Elementary 9:30am - 4:00pm
Zanewood Elementary 9:30am - 4:00pm
Not Applicable
Other
Pre-K School AM/PM:
*
Please Select
Birch Grove AM Pre-K 9:30am - 12:00pm
Birth Grove PM Pre-K 1:30pm - 4:00pm
Edinbrook AM Pre-K 8:50am - 11:20pm
Edinbrook PM Pre-K 12:50pm - 3:20pm
Elm Creek AM Pre-K 8:50am - 11:20am
Elm Creek PM Pre-K 12:50pm - 3:20pm
Fair Oaks AM Pre-K 9:30am - 12:00pm
Fair Oaks PM Pre-K 1:30pm - 4:00pm
Garden City AM Pre-K 9:30am - 12:00pm
Garden City PM Pre-K 1:30pm - 4:00pm
Oak View Pre-K AM 9:30am - 12:00pm
Oak View Pre-K PM 1:30pm - 4:00pm
Palmer Lake AM Pre-K 8:50am - 11:20pm
Palmer Lake PM Pre-K 12:50pm - 3:20pm
Park Brook Elementary 8:50am - 3:20pm
Park Brook AM Pre-K 8:50am - 11:20pm
Park Brook PM Pre-K 12:50pm - 3:20pm
Zanewood AM Pre-K 9:30am - 12:00pm
Zanewood PM Pre-K 1:30pm - 4:00pm
Not Applicable
Other
Former Address or current if hasn't changed
*
Street Address
City
State / Province
Postal / Zip Code
Current Address:
*
Street Address
City
State / Province
Postal / Zip Code
Who is moving?
*
Family
Student Only
Name, phone # and relationship of the person student staying with:
Will family remain at existing address?
Yes
No
Where is the family moving?
Does student need transportation set up through McKinney Vento?
*
Yes
No - living in attendance area of school or magnet student
No - using own transportation
No - Special Ed transportation
Other
Will student be picked up and dropped off at current address?
Yes
No
If student needs to be picked up or dropped off at a different address than where they are staying please write below the address, contact person name, phone #, is this for AM, PM or both and reason why student needs AM and or PM transportation at this address.
Nighttime Residence (Where did the student stay last night?) (REQUIRED SYNERGY)
Doubled up - temporarily sharing housing with other due to housing loss or hardship
Hotel/motel - temporarily due to housing loss or hardship
Shelter or Transitional Housing Program or FEMA Housing
Unsheltered - car, park, public place, substandard housing, etc.
(DND) Dislocated due to a natural disaster
Does the student receive EL services?
Yes
No
Does the family require an interpreter?
Yes
No
Language Preference:
Spanish
Somali
Oromo
Hmong
Other
Does the student receive Special Education services?
*
Yes
No
Does the student receive Special Education Transportation?
*
Yes
No
List ALL siblings birth to 21 who are also experiencing homelessness. NAME, AGE or GRADE and School or N/A:
*
If no siblings, please type "None"
Briefly describe the situation that lead to homelessness or if there is a change in housing status:
*
Family/Student Needs:
School Supplies
Hygiene Supplies
Clothing Resources
Food Resources
Tutoring
Kidstop
Mental Health Resources
Would Like to meet with Family Advocate
Referral for Pre-K
Fuel only gas card
Other
Back
Submit
Next
Change/Cancel Form
Type of Request:
*
Change (select for change of address, transportation, activity route, contact)
Cancel (select ONLY if canceling transportation)
Summer Program
What type of change (select all that apply):
*
Address (if new transportation is needed select both address & transportation)
Transportation
Contact information
Activity Route
Other
Student Name:
*
First Name
Last Name
Student ID Number:
*
Not Student ID
Grade:
*
Please Select
ECSE
ECFE
Pre-K
KG
01
02
03
04
05
06
07
08
09
10
11
12
School:
*
Please Select
279 Online
Anne Bremer Education Center
Arbor View Early Childhood
Basswood Elementary 8:50am - 3:20pm
Birch Grove Elementary 9:30am - 4:00pm
Brooklyn Middle School 8:10am - 2:40pm
Cedar Island Elementary 9:30am - 4:00pm
Crest View Elementary 8:40am - 3:20pm
Edinbrook Elementary 8:50am - 3:20pm
Elm Creek Elementary 8:50am - 3:20pm
Fair Oaks Elementary 9:30am - 4:00pm
Fernbrook Elementary 8:50am - 3:20pm
Garden City Elementary 9:30am - 4:00pm
Maple Grove Middle 8:10am - 2:40pm
Maple Grove Senior 7:30am - 2:00pm
NECA
North Education Center
North View Middle 8:10am - 2:40pm
Oak View Elementary 9:30am - 4:00pm
OALC 8:50am - 3:20am
Osseo Education Center 8:10am -2:40pm
Osseo Middle School 8:10am - 2:40pm
Osseo Senior High 7:30am - 2:00pm
Palmer Lake Elementary 8:50am - 3:20pm
Park Brook Elementary 8:50am - 3:20pm
Park Center Senior High 7:30am - 2:00pm
Rice Lake Elementary 8:50am - 3:20pm
Rush Creek Elementary9:30am - 4:00pm
South Education Center
Weaver Lake Elementary 9:30am - 4:00pm
West Education Center
Willow Lane Early Childhood
Woodland Elementary 9:30am - 4:00pm
Zanewood Elementary 9:30am - 4:00pm
Not Applicable
Other
Pre-K School AM/PM:
*
Please Select
Edinbrook AM Pre-K 8:50am - 11:20pm
Edinbrook PM Pre-K 12:50pm - 3:20pm
Elm Creek AM Pre-K 8:50am - 11:20am
Elm Creek PM Pre-K 12:50pm - 3:20pm
Fair Oaks AM Pre-K 9:30am - 12:00pm
Fair Oaks PM Pre-K 1:30pm - 4:00pm
Garden City AM Pre-K 9:30am - 12:00pm
Garden City PM Pre-K 1:30pm - 4:00pm
Oak View Pre-K AM 9:30am - 12:00pm
Oak View Pre-K PM 1:30pm - 4:00pm
Palmer Lake AM Pre-K 8:50am - 11:20pm
Palmer Lake PM Pre-K 12:50pm - 3:20pm
Park Brook Elementary 8:50am - 3:20pm
Park Brook AM Pre-K 8:50am - 11:20pm
Park Brook PM Pre-K 12:50pm - 3:20pm
Zanewood AM Pre-K 9:30am - 12:00pm
Zanewood PM Pre-K 1:30pm - 4:00pm
Not Applicable
Other
Not Applicable
Other
Will student need new transportation set up?
*
Yes
No
Does Student Receive Special Ed Transportation?
*
Yes
No
Will student remain at current address?
*
Yes
No
Address student is moving to:
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Explanation of Change:
*
Date of address or transportation change:
*
/
Month
/
Day
Year
Date
New or Current Address:
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Does parent, guardian or student contact info remain the same?
Yes
No
Would like to add parent, guardian or student contact info
Contact Information:
First Name
Last Name
Relationship to student:
Phone Number:
Please enter a valid phone number.
Email:
*
example@example.com
Name of Activity:
*
Day(s) or Dates of Activity:
*
Pick up time:
Hour Minutes
AM
PM
AM/PM Option
Date Activity Starts:
*
Date: 00/00/00
Date Activity Ends:
*
Date: 00/00/00
Name of Summer Program:
Additional Comments
Submit
Should be Empty: